Individual provider Active NPI

Faro Owiesy, M.D

  • Family Medicine Physician
  • Corona, CA
National Provider Identifier
1568464048
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A87796 Issued in CA
Practice address
1820 Fullerton Ave Ste 120
Corona, CA 92881-3100
Phone
(951) 371-9500
Fax
(951) 371-9194
NPI assigned
Aug 13, 2005
Reactivated
Mar 31, 2006
Last updated
Jan 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A87796 CA Primary
Geriatric Medicine (Family Medicine) Physician 207QG0300X A87796 CA

Addresses

Primary practice location

1820 Fullerton Ave Ste 120
Corona, CA 92881-3100

Mailing address

802 Magnolia Ave Ste 106
Corona, CA 92879-3125
Phone (951) 371-9500

Other identifiers 1

IdentifierTypeStateIssuer
00A877961MedicaidCA

Other names 1

  • Dr. Faro T Owiesy Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040818000529 CA Practitioner - Family PracticePractitioner - General PracticePractitioner - Interventional Pain ManagementPractitioner - Plastic and Reconstructive SurgeryPractitioner - Geriatric MedicinePractitioner - Emergency Medicine 2668445511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine, General Practice, Geriatric Medicine, Interventional Pain Management
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1820 Fullerton Ave
Suite 120
Corona, CA 92881-3100
Phone (951) 371-9500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Arbor Vitae Hospice Care, Inc. Family Medicine CurrentSince Jan 1, 2012 Accepting new patients
Faro T. Owiesy, M.D., Inc Family Medicine CurrentSince Apr 5, 2012 Accepting new patients

Locations

1820 Fullerton Ave
Ste 120
Corona, CA 92881
Phone (951) 371-4400

802 Magnolia Ave
Ste 106
Corona, CA 92879
Phone (950) 270-0882

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arbor Vitae Hospice Care, Inc.Norco, CA, CCN 751565 Hospice 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer
Corporate Director
W-2 Managing Employee
Operational/Managerial Control
May 8, 2013
Jan 1, 2012
Jan 1, 2012
Jan 1, 2012
Jan 1, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1568464048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 MAGNOLIA AVE STE 106",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793125",
            "telephone_number": "951-371-9500",
            "fax_number": "951-278-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 FULLERTON AVE STE 120",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928813100",
            "telephone_number": "951-371-9500",
            "fax_number": "951-371-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWIESY",
        "first_name": "FARO",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-13",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "deactivation_date": "2006-03-22",
        "reactivation_date": "2006-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A87796",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A87796",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A877961",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FARO",
            "last_name": "OWIESY",
            "middle_name": "T",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Corona, CA

Sources for this page

Verify at the official NPI Registry.